Provider Demographics
NPI:1588197347
Name:MAZOR-THOMAS, YEVGENIY
Entity Type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:
Last Name:MAZOR-THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 GARDINER ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1717
Mailing Address - Country:US
Mailing Address - Phone:901-262-6793
Mailing Address - Fax:
Practice Address - Street 1:181 UNION ST # J
Practice Address - Street 2:(781) 244-1950
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-244-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health